Making the right choice

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Acne

A visit to the doctor is called for if the acne is accompanied by scarring. Severe forms of acne with many purulent nodules or cysts, symptoms that persist beyond puberty and acne-like skin problems with an uncertain diagnosis are a case for the dermatologist.

Topicals with variants of vitamin A (so-called retinoids, mostly isotretinoin) are indicated for any degree of severity of acne. They regulate keratinisation and soothe inflammation. At the beginning of the application, irritation and redness may occur. For pregnant women, local treatment with the potentially teratogenic isotretinoin is contraindicated. For non-inflammatory comedone acne (acne comedonica), characterised by black or white blackheads, this treatment together with an appropriate skin care is usually sufficient.

As soon as there is an inflammation and papules and pustules (acne papulopustulosa) appear, over-the-counter topicals with benzoyl peroxide in various concentrations are indicated. Three to five percent preparations are used for mild to moderate acne, the highly irritating ten percent concentration only for severe acne. Benzoyl peroxide dries out oily skin and reduces the growth of acne bacteria. Many patients experience that their skin condition worsens (so-called »blooming« of acne) if they start applying a cream or gel with benzoyl peroxide. However, this is only temporary. The active ingredient can also burn or irritate the skin. It is best for patients to avoid sunbathing or going to a solarium because the skin reacts more sensitively to UV radiation. Moreover, benzoyl peroxide also has a bleaching effect. If you use it also on your back and décolleté, you should only wear white clothes after the application. Coloured clothing will otherwise bleach out in an unsightly way.

To counteract infections, topical antibiotics may be required in combination with topical retinoids and/or benzoyl peroxide. The doctor mostly prescribes clindamycin, erythromycin, chloramphenicol or tetracycline, usually for external use. In cases of severe inflammation and cysts, antibiotics such as doxycycline and minocycline are also used systemically, and if a topical therapy is not successful. From the severity degree of moderate acne onwards, azelaic acid is also used. It has comedolytic, anticomedogenic as well as antimicrobial and anti-inflammatory effects. In severe acne, it may be necessary to use the teratogenically effective isotretinoin systemically too.